Complex Facial Reconstruction
Complex facial reconstruction restores form and function to the face and neck after a tumor, trauma or malformation. Each case is approached with whichever reconstructive technique best fits it — from local flaps to free-flap microsurgery — depending on the extent of the defect.
When is it recommended?
- Defects following the removal of head and neck tumors.
- Complex facial trauma involving tissue loss.
- Sequelae of previous surgeries requiring secondary reconstruction.
- Cases requiring a multidisciplinary approach alongside oncology and radiotherapy.
My approach
I adapt the reconstructive technique to each defect, always prioritizing the simplest solution that guarantees a good functional and aesthetic result. For the most extensive cases, my training in reconstructive microsurgery at centers such as Hong Kong, Buenos Aires and Charité Berlin, together with my research work in tissue engineering at VHIR, lets me also offer the most advanced techniques when they are needed.
The reconstructive ladder: from simple to complex
Reconstructive surgery follows a classic principle: choose the simplest technique that solves the problem well, not the most spectacular. Direct closure works for small defects. Skin grafts cover surface area but add no volume. Local flaps — neighbouring tissue mobilized while keeping its own blood supply — resolve most medium-sized facial defects with excellent colour and texture match, because the tissue comes from the same area. Regional flaps bring more volume from nearby zones such as the neck or chest. And at the top of the ladder are microsurgical free flaps, in which tissue is transferred from the fibula, forearm or thigh and its vessels connected to those of the neck by suturing under a microscope. Climbing the ladder unnecessarily adds risk without adding benefit.
Virtual planning and guided surgery
Mandibular and maxillary reconstruction has changed radically over the past decade thanks to virtual planning. From the patient’s CT scan a three-dimensional model is built, tumour resection is simulated, and the way the fibula bone must be cut and folded to reproduce the original shape of the mandible is designed on computer. From that design, custom cutting guides and patient-specific plates are manufactured, 3D-printed and taken to the operating room. The result is more precise, shorter surgery with an anatomically more faithful reconstruction, which also facilitates later rehabilitation with dental implants. At Vall d’Hebron we work routinely with this methodology, and one of my research lines at VHIR explores precisely the next step: 3D-printed tissue scaffolds to regenerate mandibular bone.
The multidisciplinary approach
Complex facial reconstruction is rarely a one-specialist affair. In oncologic cases, the plan is decided by a tumour board involving maxillofacial surgery, ENT, medical oncology, radiation oncology, radiology and pathology; there it is defined whether surgery, radiotherapy, chemotherapy or a combination is appropriate, and in what order. Depending on the case, this is joined by rehabilitation, speech therapy — essential when speech or swallowing are affected —, nutrition and dentistry for final prosthetic rehabilitation. Working at a reference university hospital such as Vall d’Hebron means having that entire pathway available and coordinated, something that in extensive reconstructions shapes the outcome as much as the surgical technique itself.
Recovery
Recovery time depends directly on the extent of the reconstruction: from a few days for small defects to several weeks of admission and close follow-up for free-flap reconstructions. In every case I coordinate the postoperative course with the oncology team or the department involved.
Frequently Asked Questions
Does every complex facial reconstruction require microsurgery?
No. Many defects are resolved with local or regional flaps, without needing microsurgery. I reserve microsurgical free-flap techniques for the most extensive defects, where there isn't enough nearby tissue to reconstruct the area.
Who might need complex facial reconstruction?
Mainly oncology patients after removal of a head and neck tumor, people with severe facial trauma, and cases with sequelae from previous surgeries that require secondary reconstruction.
Is there a risk of damaging the facial nerve during reconstruction?
It is a real risk when surgery involves the parotid gland or structures near the facial nerve's path, which is why identifying and preserving its branches is a priority in every procedure. When the tumor or trauma itself has already damaged the nerve, reconstruction is planned with its possible repair or later reanimation also in mind.